The Patient-Centered Medical Home (PCMH) model involves complete primary care practice redesign with the ultimate goal to improve the quality of patient care and reduce cost. Detailed information on the best methods of practice transformation is needed to help the growing number of practices as they plan to go through this process. The overall objective of this study is to evaluate the adoption and process of transformational change in primary care practices belonging to the North Carolina Improving Performance in Practice program (NC IPIP), examine how specific components of the change relate to key health outcomes and explore environmental, organizational and financial conditions that are conducive to transformational change. The aims of this study are to 1) confirm the transformational change process that has occurred within 40 selected practices in the NC IPIP, 2) evaluate which components of change are most linked with improvement in the quality care indicators for diabetes and asthma, 3) for a subset of 12 practices that evidence varying degrees of success in implementing transformational change, utilize quantitative and qualitative methods to obtain a richer understanding of the change process, examine the effect of environmental conditions, organizational characteristics and financial resources on the change process and describe the costs involved in transformational change at the practice level, and 4) provide a set of recommendations that can be applied at the individual practice level and at the health care organization level to assist in the PCMH transformation process. The ultimate goal and the significance of this study is to describe the transformation process and arrive at a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model. PUBLIC HEALTH RELEVANCE: The Patient-Centered Medical Home (PCMH) describes a health care setting that facilitates partnerships between individual patients and their personal physicians. The PCMH model improves patient access to care and quality of care. In this study, the researchers plan to evaluate the adoption and process of this transformational change and examine how specific components of the change relate to key health outcomes. This project is highly relevant to public health as it will enhance understanding of the transformation process in practice and provide a set of implementable recommendations that can be shared broadly to assist individual practices and health care organizations moving toward the PCMH model.